Property of the diagnostic odds ratio based on various kinds of accuracy measures

BACKGROUND It is important to exploit all available data on patients in settings such as Intensive Care Burn Units (ICBUs), where several variables are recorded over time. It is possible to take advantage of the multivariate patterns that model the evolution of patients in order to predict their survival. However, pattern discovery algorithms generate a large number of patterns, of which only some are relevant for classification. The interpretability of the model is, moreover, an essential property in the clinical domain. OBJECTIVE We propose to use the Diagnostic Odds Ratio (DOR) to select the multivariate sequential patterns used in the classification in a clinical domain, rather than employing frequency properties. This makes it possible to employ a terminology closer to the language of clinicians, in which a pattern is considered to be a risk factor or to have a protection factor. METHODS We employ data obtained from the ICBU at the University Hospital of Getafe, where six temporal variables for 465 patients were registered every day during 5 days, and to model the evolution of these clinical variables we use multivariate sequential patterns. We compare four ways in which to employ the DOR for pattern selection: 1) We use it as a threshold in order to select patterns with a minimum DOR; 2) We select patterns whose differential DORs are higher than a threshold as regards their extensions; 3) We select patterns whose DOR confidence intervals do not overlap; and 4) We propose the combination of threshold and non-overlapping confidence intervals in order to select the most discriminative patterns. As a baseline, we compare our proposals with Jumping Emerging Patterns (JEPs), one of the most frequently used techniques for pattern selection that utilize frequency properties. RESULTS We have compared the number and length of the patterns eventually selected, classification performance, and pattern and model interpretability. We show that discretization has a great impact on the accuracy of the classification model, but that a trade off must be found between classification accuracy and the physicians' capacity to interpret the patterns obtained. We have, therefore, opted to use expert discretization without losing too much accuracy. We have also identified that the experiments combining threshold and non-overlapping confidence intervals (Option 4) obtained the fewest number of patterns but also with the smallest size, thus implying the loss of an acceptable accuracy as regards clinician interpretation. CONCLUSIONS A method for the classification of patients’ survival can benefit from the use of sequential patterns, since these patterns consider knowledge about the temporal evolution of the variables in the case of ICBU. We have proved that the DOR can be used in several ways, and that it is a suitable measure with which to select discriminative and interpretable quality patterns.

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Clinical utility of microRNA-451 as diagnostic biomarker for human cancers

Bioscience Reports ◽

10.1042/bsr20180653 ◽

2019 ◽

Vol 39 (1) ◽

Cited By ~ 4

Author(s):

Zhanzhan Li ◽

Yanyan Li ◽

Jun Fu ◽

Na Li ◽

Liangfang Shen

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Random Effect ◽

Random Effect Model ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Diagnostic Ability ◽

Sensitivity Specificity

AbstractWe conducted comprehensive analyses to assess the diagnostic ability of miRNA-451 in cancers. A systematic online search was conducted in PubMed, Web of Science, China’s national knowledge infrastructure, and VIP databases from inception to July 31, 2017. The bivariate random effect model was used for calculating sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under cure (AUC). The whole pooled sensitivity and specificity were 0.85 (0.77–0.90) and 0.85 (0.78–0.90) with their 95% confidence interval (95%CI), respectively. The pooled AUC was 0.91 (95%CI: 0.89–0.94). Positive likelihood ratio was 5.57 (95%CI: 3.74–8.31), negative likelihood ratio was 0.18 (95%CI: 0.11–0.28), and diagnostic odds ratio was 31.33 (95%CI: 15.19–64.61). Among Asian population, the sensitivity and specificity were 0.85 (95%CI: 0.77–0.91) and 0.86 (95%CI: 0.78–0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 5.87 (95%CI: 3.78–9.12) and 0.17 (95%CI: 0.11–0.28). The diagnostic odds ratio and AUC were 34.31 (15.51–75.91) and 0.92 (0.89–0.94). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and AUC for digestive system cancer were 0.83, 0.88, 6.87, 0.20, 35.13, and 0.92, respectively. The other cancers were 0.87, 0.81, 4.55, 0.16, 28.51, and 0.90, respectively. For sample source, the results still remain consistent. Our results indicated miRNA-451 has a moderate diagnostic ability for cancers, and could be a potential early screening biomarker, and considered as an adjuvant diagnostic index when being combined with other clinical examinations.

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Furosemide stress test as a predictive marker of acute kidney injury progression or renal replacement therapy: a systemic review and meta-analysis

10.21203/rs.2.23355/v2 ◽

2020 ◽

Author(s):

Jia-Jin Chen ◽

Chih-Hsiang Chang ◽

Yen Ta Huang ◽

George Kuo

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Diagnostic Accuracy ◽

Replacement Therapy ◽

Sensitivity And Specificity ◽

Odds Ratio ◽

Diagnostic Performance ◽

Stress Test ◽

Kidney Injury ◽

Diagnostic Odds Ratio

Abstract Background: The use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been described in several trials. However, the diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Cochrane databases up to March, 2020. The diagnostic performance of the FST (in terms of sensitivity, specificity, number of events, true positive, false positive) was extracted and evaluated. Results: We identified eleven trials that enrolled a total of 1366 patients, including 517 patients and 1017 patients for whom the outcomes in terms of AKI stage progression and renal replacement therapy (RRT), respectively, were reported. The pooled sensitivity and specificity results of the FST for AKI progression prediction were 0.81 (95% CI: 0.74 - 0.87) and 0.88 (95% CI: 0.82- 0.92), respectively. The pooled positive likelihood ratio (LR) was 5.45 (95% CI: 3.96-7.50), the pooled negative LR was 0.26 (95% CI: 0.19-0.36), and the pooled diagnostic odds ratio (DOR) was 29.69 (95% CI: 17.00-51.85). The summary receiver operating characteristics (SROC) with pooled diagnostic accuracy was 0.88. The diagnostic performance of the FST in predicting AKI progression was not affected by different AKI criteria or underlying chronic kidney disease. The pooled sensitivity and specificity results of the FST for RRT prediction were 0.84 (95% CI: 0.72-0.91) and 0.77 (95% CI: 0.64-0.87), respectively. The pooled positive LR and pooled negative LR were 3.16 (95% CI: 2.06-4.86) and 0.25 (95% CI: 0.14-0.44), respectively. The pooled diagnostic odds ratio (DOR) was 13.59 (95% CI: 5.74-32.17) and SROC with pooled diagnostic accuracy was 0.86. The diagnostic performance of FST for RRT prediction is better in stage 1-2 AKI comparing to stage 3 AKI (relative DOR: 5.75, 95% CI: 2.51-13.33) Conclusion: The FST is a simple tool for the identification of AKI populations at high risk of AKI progression and the need for RRT and the diagnostic performance of FST in RRT prediction is better in early AKI population.

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Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3857 ◽

2018 ◽

Vol 56 (214) ◽

pp. 917-923

Author(s):

Niresh Thapa ◽

Muna Maharjan ◽

Girishma Shrestha ◽

Narayani Maharjan ◽

Deborah Lindell ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Negative Predictive Value ◽

Cervical Cancer Screening ◽

Predictive Value ◽

Odds Ratio ◽

Screening Program ◽

Diagnostic Odds Ratio ◽

Screening Tests ◽

Resource Setting

Introduction: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol’s Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal.Methods: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. Results: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7).Conclusions: Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

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Prognostic Value of N-terminal Probrain Natriuretic Peptide for Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/3472615 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Qi Ni ◽

Chaoqian Li ◽

Hua Lin

Keyword(s):

Systematic Review ◽

Acute Respiratory Distress Syndrome ◽

Likelihood Ratio ◽

Odds Ratio ◽

Distress Syndrome ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Sensitivity Specificity

Objectives. The mortality rate of patients with acute respiratory distress syndrome (ARDS) is high. Hence, it is crucial to identify a reliable biomarker with wide clinical applications for predicting the prognosis of patients with ARDS. This systematic review and meta-analysis was conducted to investigate the value of plasma N-terminal probrain natriuretic peptide (NT-proBNP) for predicting mortality in patients with ARDS. Methods. An electronic search of databases including PubMed, Web of Science, Cochrane Library, and Chinese National Knowledge Infrastructure was conducted up to May 31, 2019, without language restrictions. The quality of the included studies was evaluated using QUADAS-2. Data were extracted and analyzed to obtain pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A forest graph was used to evaluate heterogeneity. Potential causes of heterogeneity were further explored by subgroup analysis based on the testing day, testing method, observation endpoint, or cut-off points. A summary receiver operating characteristic curve was drawn to obtain the pooled area under the curve. Results. A total of 7 studies involving 581 patients with ARDS were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were as follows: 0.79 (95% CI: 0.72–0.84), 0.79 (95% CI: 0.66–0.88), 3.68 (95% CI: 2.16–6.28), 0.27 (95% CI: 0.20–0.38), and 13.58 (95% CI: 6.17–29.90), respectively. The results of subgroup analysis showed that the testing day influenced the summary sensitivity and that the cut-off points influenced the summary sensitivity and specificity. Conclusion. Our results indicate that elevated plasma NT-proBNP levels have a moderate value for predicting the mortality of patients with ARDS.

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Accuracy of multiparametric MRI in distinguishing the breast malignant lesions from benign lesions: a meta-analysis

Acta Radiologica ◽

10.1177/0284185120963900 ◽

2020 ◽

pp. 028418512096390

Author(s):

Chun-Rong Zhu ◽

Ke-Yu Chen ◽

Pan Li ◽

Zhi-Yang Xia ◽

Bin Wang

Keyword(s):

Likelihood Ratio ◽

Odds Ratio ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Multiparametric Mri ◽

Benign Lesions ◽

Malignant Lesions ◽

Sensitivity Specificity

Background The sensitivity of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for detecting breast cancer was high and the specificity was relatively low. However, diffusion-weighted imaging (DWI) has a high specificity in the diagnosis of malignant lesions. Purpose To evaluate the accuracy of the multiparametric MRI (mp-MRI) in distinguishing the breast malignant lesions from the benign lesions. Material and Methods A comprehensive search of the PubMed, Embase, and Cochrane Library electronic databases was conducted up to March 2020. Data were analyzed for the following indexes: pooled sensitivity and specificity; positive likelihood ratio; negative likelihood ratio; diagnostic odds ratio; and the area under the curve. Results A total of 2356 patients with 1604 malignant and 967 benign breast lesions were included from 22 studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve for mp-MRI were 0.93, 0.85, 6.3, 0.08, 81, and 0.96, respectively. The pooled sensitivity, specificity, and area under the curve for DCE-MRI alone were 0.95, 0.71, and 0.92, respectively. The pooled sensitivity, specificity, and area under the curve for DWI alone were 0.88, 0.84, and 0.93, respectively. Conclusion The mp-MRI did not improve the sensitivity but increased the specificity for the diagnosis of breast malignant lesions.

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Systematic Review with Meta-Analysis: Fecal Calprotectin as a Surrogate Marker for Predicting Relapse in Adults with Ulcerative Colitis

Mediators of Inflammation ◽

10.1155/2019/2136501 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Jiajia Li ◽

Xiaojing Zhao ◽

Xueting Li ◽

Meijiao Lu ◽

Hongjie Zhang

Keyword(s):

Ulcerative Colitis ◽

Receiver Operating Characteristic ◽

Likelihood Ratio ◽

Odds Ratio ◽

Operating Characteristic ◽

Diagnostic Odds Ratio ◽

Fecal Calprotectin ◽

Clinical Relapse ◽

Sensitivity Specificity ◽

Receiver Operating

The clinical course of ulcerative colitis (UC) is featured by remission and relapse, which remains unpredictable. Recent studies revealed that fecal calprotectin (FC) could predict clinical relapse for UC patients in remission, which has not yet been well accepted. To detect the predictive value of FC for clinical relapse in adult UC patients based on updated literature, we carried out a comprehensive electronic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify all eligible studies. Diagnostic accuracy including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic (AUROC) was calculated using a random effects model. Heterogeneity across studies was assessed by the I2 metric. Sources of heterogeneity were detected using subgroup analysis. Metaregression was used to test potential factors correlated to DOR. Publication bias was assessed using Deek’s funnel plots. In our study, 14 articles enrolling a total of 1110 participants were finally included, and all articles underwent a quality assessment. Pooled sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.75 (95% CI: 0.70–0.79), 0.77 (95% CI: 0.74–0.80), 3.45 (95% CI: 2.31–5.14), and 0.37 (95% CI: 0.28–0.49) respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.82, and the diagnostic odds ratio was 10.54 (95% CI: 6.16–18.02). Our study suggested that FC is useful in predicting clinical relapse for adult UC patients in remission as a simple and noninvasive marker.

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Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort

Journal of Child Neurology ◽

10.1177/0883073820901415 ◽

2020 ◽

Vol 35 (6) ◽

pp. 363-379

Author(s):

Katherine Schiller ◽

Asim F. Choudhri ◽

Tamekia Jones ◽

Christen Holder ◽

James W. Wheless ◽

...

Keyword(s):

Functional Mri ◽

Odds Ratio ◽

Magnetic Stimulation ◽

Diagnostic Odds Ratio ◽

Functional Magnetic Resonance ◽

Resonance Imaging ◽

Clinical Cohort ◽

Brodmann Areas ◽

Magnetic Resonance Imaging Mri ◽

Language Areas

Transcranial magnetic stimulation (TMS) is a newer noninvasive language mapping tool that is safe and well-tolerated by children. We examined the accuracy of TMS-derived language maps in a clinical cohort by comparing it against functional magnetic resonance imaging (MRI)–derived language map. The number of TMS-induced speech disruptions and the volume of activation during functional MRI tasks were localized to Brodmann areas for each modality in 40 patients with epilepsy or brain tumor. We examined the concordance between TMS- and functional MRI–derived language maps by deriving statistical performance metrics for TMS including sensitivity, specificity, accuracy, and diagnostic odds ratio. Brodmann areas 6, 44, and 9 in the frontal lobe and 22 and 40 in the temporal lobe were the most commonly identified language areas by both modalities. Overall accuracy of TMS compared to functional MRI in localizing language cortex was 71%, with a diagnostic odds ratio of 1.27 and higher sensitivity when identifying left hemisphere regions. TMS was more accurate in determining the dominant hemisphere for language with a diagnostic odds ratio of 6. This study is the first to examine the accuracy of the whole brain language map derived by TMS in the largest cohort examined to date. While this comparison against functional MRI confirmed that TMS reliably localizes cortical areas that are not essential for speech function, it demonstrated only slight concordance between TMS- and functional MRI–derived language areas. That the localization of specific language cortices by TMS demonstrated low accuracy reveals a potential need to use concordant tasks between the modalities and other avenues for further optimization of TMS parameters.

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Blood circulating miRNAs as biomarkers of Alzheimer’s disease: a systematic review and meta-analysis

Biomarkers in Medicine ◽

10.2217/bmm-2018-0341 ◽

2019 ◽

Vol 13 (12) ◽

pp. 1045-1054

Author(s):

Ya-Heng Zhang ◽

Shu-Feng Bai ◽

Jun-Qiang Yan

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Odds Ratio ◽

Diagnostic Performance ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

Circulating Mirnas ◽

Cognitively Normal ◽

Specificity And Sensitivity ◽

Normal Controls

Aim: It is already known that miRNAs can be differentially expressed in Alzheimer’s disease (AD). We aimed to evaluate the performance of miRNAs from blood as potential biomarkers for AD. Materials & methods: MEDLINE, PubMed and Embase were searched for studies about peripheral blood miRNAs that could discriminate patients with AD from cognitively normal controls. The data regarding the specificity and sensitivity were extracted. STATA 14.0 was used to analyze the data. Results: Ten studies containing 770 AD and 664 normal controls. The analysis showed that miRNAs presented excellent diagnostic performance and the overall sensitivity was 0.80 (95% CI: 0.75–0.83), specificity was 0.83 (95% CI: 0.78–0.87) and diagnostic odds ratio was 14 (95% CI: 11–19). Subgroup analysis suggested that the Caucasian group and blood group showed a better performance in AD diagnosis and the diagnostic odds ratio was 42 and 34, respectively. Conclusion: This meta-analysis showed that miRNAs may be a promising biomarkers for AD.

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Prospective Validation of a Predictive Model for Early Anemia in Patients Receiving Cancer Chemotherapy.

Blood ◽

10.1182/blood.v108.11.460.460 ◽

2006 ◽

Vol 108 (11) ◽

pp. 460-460

Author(s):

Gary H. Lyman ◽

David C. Dale ◽

Nicole M. Kuderer ◽

Debra A. Wolff ◽

Eva Culakova ◽

...

Keyword(s):

Predictive Model ◽

Odds Ratio ◽

Risk Model ◽

Diagnostic Odds Ratio ◽

Performance Characteristics ◽

Model Fit ◽

Lower Sensitivity ◽

Cancer Type ◽

C Statistic ◽

Increased Risk

Abstract Anemia represents the most common hematological toxicity in cancer patients receiving chemotherapy and is associated with considerable morbidity and cost. ASH/ASCO guidelines call for intervention at a hemoglobin (hgb)<10 g/dL. A meta-analysis has demonstrated the clinical value of early (hgb≥10 g/dL) versus late (hgb<10 g/dL) intervention with an erythroid stimulating protein (ESP). An anemia predictive model may help guide intervention sufficiently early in the course of chemotherapy when it can be most effective. A prospective, nationwide study was undertaken to develop and validate risk models for hematologic toxicities of chemotherapy. The analysis presented here is based on 3,640 patients with cancer of the breast, lung, colon and ovary or malignant lymphoma receiving a new regimen prospectively registered at 117 randomly selected U.S. practices. A logistic regression model for hgb<10 g/dL was developed and validated using a 2:1 random selection split sample methodology. Predictive performance characteristics were estimated [±95% CL]. Nadir hgb over 4 cycles of chemotherapy was <8 g/dL in 113 (3%), 8–10 in 959 (26%), 10–12 in 1,847 (51%), and ≥12 in 721 (20%). No significant differences were observed between the two populations. Independent risk factors for nadir hgb<10 g/dL (ORs) were: female gender (1.66); ECOG >1 (1.70); CHF (1.54); history of vascular disease (2.66); ulcer disease (2.58); COPD (1.29); connective tissue disease (1.84); advanced cancer stage (1.19); cancer type and chemotherapy based on anthracyclines (2.15), carboplatin (2.40), gemcitabine (2.48), cyclophosphamide (1.60), etoposide (2.84), topotecan (4.21), or trastuzumab (1.43), planned cycle length >1 week (2.0), while normal baseline hemoglobin, platelet count and GFR were associated with a reduced risk. Model fit was good (P<.001), R2 = 0.35 and c-statistic = 0.81 [.79–.83, P<.0001]. Mean and median predicted risk for hgb<10 g/dL were 0.29 and 0.22, respectively. An increasing risk cutpoint was associated with lower sensitivity and higher specificity. In the highest risk half, quarter and quintile of patients, hgb<10 g/dL was experienced by 47% [45–50], 64% [60–68], and 70% [65–74], respectively. Model performance characteristics at the median risk included: sensitivity: 82% [78–84]; specificity: 64% [62–66]; and diagnostic odds ratio: 7.80 [6.28–9.68]. Most covariates significant in the derivation model remained significant in the validation population. Model fit was good [P<.001] with an R2=.40 and a c-statistic of 0.83 [.81–.86; P<.001]. In the highest risk half, quarter and quintile of patients, hgb<10 g/dL was experienced by 50% [46–54], 67% [62–71], and 70% [65–75], respectively. Test performance of the validation model at the median risk included: sensitivity of 83% [79–86], specificity of 62% [59–66], and a diagnostic odds ratio of 7.90 [5.84–10.69]. Based on good performance characteristics, this validated prediction model identified chemotherapy patients at increased risk for developing clinically significant anemia who may be candidates for early targeted intervention with an ESP. A conditional risk model for subsequent risk of hgb<10 g/dL which includes changes during cycle 1 of chemotherapy has also been developed and will be presented.

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